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<p class="p_Heading1"><span class="f_Heading1">HIV Care Static Form: Initial Evaluation</span></p>
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<td colspan="9" valign="top" width="467" style="width:467px; height:17px; border: solid 1px #000000;"><p><span style="font-weight: bold;">Initial Evaluation Business Rules</span></p>
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<td colspan="2" valign="top" style="height:15px; border: solid 1px #000000;"><p><span style="font-weight: bold;">General Rules:</span></p>
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<td colspan="9" valign="top" width="258" style="width:258px; height:15px; border: solid 1px #000000;"><p>If a patient is reactivated, the physician can fill out a new IE form (or a FU form); and therefore there can be more than one instance of the IE form in IQCare</p>
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<td colspan="3" valign="top" style="height:15px; border: solid 1px #000000;"><p>Paperless: ARV Therapy is not a required field</p>
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<td valign="top" width="45" style="width:45px; height:54px; border: solid 1px #000000;"><p><span style="font-weight: bold;">Form No.</span></p>
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<td valign="top" width="93" style="width:93px; height:54px; border: solid 1px #000000;"><p><span style="font-weight: bold;">Form Label</span></p>
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<td valign="top" width="154" style="width:154px; height:54px; border: solid 1px #000000;"><p><span style="font-weight: bold;">Database Table</span></p>
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<td valign="top" width="74" style="width:74px; height:54px; border: solid 1px #000000;"><p><span style="font-weight: bold;">Field Name</span></p>
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<td valign="top" width="209" style="width:209px; height:54px; border: solid 1px #000000;"><p><span style="font-weight: bold;">Business Rule</span></p>
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<td valign="top" width="52" style="width:52px; height:54px; border: solid 1px #000000;"><p><span style="font-weight: bold;">De-identified Field</span></p>
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<td valign="top" width="64" style="width:64px; height:54px; border: solid 1px #000000;"><p><span style="font-weight: bold;">Required for Saving</span></p>
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<td valign="top" width="73" style="width:73px; height:54px; border: solid 1px #000000;"><p><span style="font-weight: bold;">Minimum Reporting</span></p>
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<td valign="top" width="69" style="width:69px; height:54px; border: solid 1px #000000;"><p><span style="font-weight: bold;">Minimum Clinical</span></p>
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<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>1</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>First Name</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>mst_Patient </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>FirstName</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Auto filled</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>1</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Last Name</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>mst_Patient </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>LastName</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Auto filled</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>2</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Visit Date</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>ord_Visit </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>VisitDate</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>Date on which the patient came into the clinic.<br>
No future dates allowed - like 2020</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>3</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>ID - Country</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>mst_Facility </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>CountryID</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Auto filled</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>3</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>ID - LPTF#</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>mst_Facility </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>PosID</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Auto filled</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>3</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>ID - Satellite #</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>mst_Facility </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>satelliteID</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Auto filled</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>3</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>ID - Patient Enrollment Number</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>mst_Patient </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>PatientEnrollmentID</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>Auto filled</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>3</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Existing Hosp/Clinic #</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>mst_Patient </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>PatientClinicID</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Auto filled</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>5a</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Date of HIV diagnosis</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>DateHIVDiagnosis</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>5b</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Diagnosis verified</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>HIVDiagnosisVerified</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>It’s a yes, no field</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:45px; border: solid 1px #000000;"><p>6</p>
</td>
<td valign="top" width="93" style="width:93px; height:45px; border: solid 1px #000000;"><p>Disclosed</p>
</td>
<td valign="top" width="154" style="width:154px; height:45px; border: solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td valign="top" width="74" style="width:74px; height:45px; border: solid 1px #000000;"><p>Disclosure</p>
</td>
<td valign="top" width="209" style="width:209px; height:45px; border: solid 1px #000000;"><p>Although this is a similar question to the HIV Disclosure status quesiton on the Enrollment form, it is handled separately.</p>
</td>
<td valign="top" width="52" style="width:52px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:90px; border: solid 1px #000000;"><p>6</p>
</td>
<td valign="top" width="93" style="width:93px; height:90px; border: solid 1px #000000;"><p>Who to</p>
</td>
<td valign="top" width="154" style="width:154px; height:90px; border: solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td valign="top" width="74" style="width:74px; height:90px; border: solid 1px #000000;"><p>DisclosureName</p>
</td>
<td valign="top" width="209" style="width:209px; height:90px; border: solid 1px #000000;"><p>This should be a select box with the same options as for the field: dtl_PatientHivOther::HIVDisclosure &nbsp;Because this is a text box on the IE form, there is a possiblilty that different information may be entered than in the select box. The data entry person have to update the master table appropriately.</p>
</td>
<td valign="top" width="52" style="width:52px; height:90px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:90px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:90px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:90px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:45px; border: solid 1px #000000;"><p>7</p>
</td>
<td valign="top" width="93" style="width:93px; height:45px; border: solid 1px #000000;"><p>Pregnant</p>
</td>
<td valign="top" width="154" style="width:154px; height:45px; border: solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td valign="top" width="74" style="width:74px; height:45px; border: solid 1px #000000;"><p>Pregnant</p>
</td>
<td valign="top" width="209" style="width:209px; height:45px; border: solid 1px #000000;"><p>The field should only display or be editable (can gray out) if the patient has Gender=female</p>
<p>This should be defaulted to "No"</p>
</td>
<td valign="top" width="52" style="width:52px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:45px; border: solid 1px #000000;"><p>Yes - if female</p>
</td>
<td valign="top" width="69" style="width:69px; height:45px; border: solid 1px #000000;"><p>Yes - if female</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>7</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>LMP</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>LMP</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>LMP= Last Menstral Period</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p>Yes - if female</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Presenting Complaints</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>8</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Presenting Complaints</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientSymptoms </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>SymptomID</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>Default the UI to None; if other complaints are selected, None becomes de-selected.</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Medical History</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:165px; border: solid 1px #000000;"><p>10</p>
</td>
<td valign="top" width="93" style="width:93px; height:165px; border: solid 1px #000000;"><p>Medical History - None, Liver, Kidney, Anaemia, etc.</p>
</td>
<td valign="top" width="154" style="width:154px; height:165px; border: solid 1px #000000;"><p>dtl_PatientDisease</p>
</td>
<td valign="top" width="74" style="width:74px; height:165px; border: solid 1px #000000;"><p>DiseasePresent</p>
</td>
<td valign="top" width="209" style="width:209px; height:165px; border: solid 1px #000000;"><p>No UI defaults<br>
1) If None is selected, then Liver, kidney, anemia and drug/alcohol abuse are given the answer of “none’ or null; <br>
2) If one or more diseases are selected, and the others are not filled out, then the others get "none". (or only those that get filled in reside in the databae with the assumption that if it is not captured, then the value is "none")<br>
3) If nothing is selected, then the Not Documented button must be selected.</p>
</td>
<td valign="top" width="52" style="width:52px; height:165px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:165px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:165px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:165px; border: solid 1px #000000;"><p>None, filled in data, or Not documented</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>10</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Disease</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientDisease</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>Disease_Pk</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>10</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Disease year</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientDisease</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>DateOfDisease</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>For each new year, the current year is added to the list.</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>11</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Allergies -- None</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientAllergy </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>AllergyID</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Allergies -- Not documented</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:45px; border: solid 1px #000000;"><p>11</p>
</td>
<td valign="top" width="93" style="width:93px; height:45px; border: solid 1px #000000;"><p>Allergies - Sulfa drugs</p>
</td>
<td valign="top" width="154" style="width:154px; height:45px; border: solid 1px #000000;"><p>dtl_PatientAllergy </p>
</td>
<td valign="top" width="74" style="width:74px; height:45px; border: solid 1px #000000;"><p>AllergyID</p>
</td>
<td valign="top" width="209" style="width:209px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:45px; border: solid 1px #000000;"><p>None, Yes, or Not documented</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>11</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Allergies -- Other (specify)</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientAllergy </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>AllergyID</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:45px; border: solid 1px #000000;"><p>12</p>
</td>
<td valign="top" width="93" style="width:93px; height:45px; border: solid 1px #000000;"><p>Long Term Medications - Sulfa/TMP</p>
</td>
<td valign="top" width="154" style="width:154px; height:45px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:45px; border: solid 1px #000000;"><p>LongTermMedsSulfa</p>
</td>
<td valign="top" width="209" style="width:209px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:45px; border: solid 1px #000000;"><p>None, Yes, or Not documented</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>12</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Long Term Medications - TB Rx (specify)</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>LongTermTBMed</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>12</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Long Term Medications - TB Date</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>LongTermTBStartDate</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>12</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Long Term Medications - Other1, Other2 Description</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>longTermMedsOther1Desc</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>Two "other long term meds" available</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>HIV Related History</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>13</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Lowest CD4 Count</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>PrevLowestCD4</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Units = c/mm3</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>13</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Lowest CD4 Percent</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>PrevLowestCD4Percent</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Whole number, no decimals; should not execeed 99%</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>13</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Lowest CD4 Date</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>PrevLowestCD4Date</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>13b</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>CD4 prior to starting ARV Count</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>PriorARVsCD4</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>13b</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>CD4 prior to starting ARV Percent</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p> PrevARVScd4pRECENT</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>13b</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>CD4 prior to starting ARV Date</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>PriorARVsCD4Date</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>14</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Most recent CD4<br>
Last CD4 Count</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>MostRecentCD4</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>Check that this date is before the visit date.</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p>14</p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Most Recent CD4 Percent</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>MostRecentCD4Percent</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Whole number, no decimals; should not execeed 99%</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>14</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Most recent CD4 Date<br>
Last CD4 Count Date</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>MostRecentCD4Date</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>15</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Pre-therapy Viral Load<br>
Last Viral Load</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>MostRecentViralLoad</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>Whole number, no decimals</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>15</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Pre-therapy Viral Load Date<br>
Last Viral Load Date</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>MostRecentViralLoadDate</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:90px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:90px; border: solid 1px #000000;"><p>ARV exposure - None</p>
</td>
<td valign="top" width="154" style="width:154px; height:90px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:90px; border: solid 1px #000000;"><p>PrevARVExposure</p>
</td>
<td valign="top" width="209" style="width:209px; height:90px; border: solid 1px #000000;"><p>Do not default UI to None.<br>
If None has be select and any other of the fields in this section are filled in, None becomes unchecked.<br>
If other fields are filled in and None is then checked, an alert message appear notifying the user that the fields will be cleared.</p>
</td>
<td valign="top" width="52" style="width:52px; height:90px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:90px; border: solid 1px #000000;"><br>
</td>
<td valign="top" width="73" style="width:73px; height:90px; border: solid 1px #000000;"><p>Yes <br>
Either "none", "single dose NVP" or "ARVs" must be selected</p>
</td>
<td valign="top" width="69" style="width:69px; height:90px; border: solid 1px #000000;"><p>Yes - if none other in this section selected</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:90px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:90px; border: solid 1px #000000;"><p>Historical ART</p>
</td>
<td valign="top" width="154" style="width:154px; height:90px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:90px; border: solid 1px #000000;"><p>Previous ART</p>
</td>
<td valign="top" width="209" style="width:209px; height:90px; border: solid 1px #000000;"><p>Use of drug helper which allows the User to select the drugs that make up the regimen</p>
</td>
<td valign="top" width="52" style="width:52px; height:90px; border: solid 1px #000000;"><br>
</td>
<td valign="top" width="64" style="width:64px; height:90px; border: solid 1px #000000;"><p>Yes if Previous ARV exposure not equal to "None"</p>
</td>
<td valign="top" width="73" style="width:73px; height:90px; border: solid 1px #000000;"><p>Yes if Previous ARV exposure not equal to "None"</p>
</td>
<td valign="top" width="69" style="width:69px; height:90px; border: solid 1px #000000;"><p>Yes if Previous ARV exposure not equal to "None"</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:105px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:105px; border: solid 1px #000000;"><p>Historical Start Date</p>
</td>
<td valign="top" width="154" style="width:154px; height:105px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:105px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:105px; border: solid 1px #000000;"><p>mm/yy</p>
</td>
<td valign="top" width="52" style="width:52px; height:105px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:105px; border: solid 1px #000000;"><br>
</td>
<td valign="top" width="73" style="width:73px; height:105px; border: solid 1px #000000;"><p>Yes<br>
We need to know whether they have been on ART for the last three months</p>
</td>
<td valign="top" width="69" style="width:69px; height:105px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:90px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:90px; border: solid 1px #000000;"><p>Previous Single dose NVP</p>
</td>
<td valign="top" width="154" style="width:154px; height:90px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:90px; border: solid 1px #000000;"><p>PrevSingleDoseNVP</p>
</td>
<td valign="top" width="209" style="width:209px; height:90px; border: solid 1px #000000;"><p>Check box which opens two date fields</p>
</td>
<td valign="top" width="52" style="width:52px; height:90px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:90px; border: solid 1px #000000;"><br>
</td>
<td valign="top" width="73" style="width:73px; height:90px; border: solid 1px #000000;"><p>Yes if Previous ARV exposure not equal to "None"</p>
</td>
<td valign="top" width="69" style="width:69px; height:90px; border: solid 1px #000000;"><p>Yes if Previous ARV exposure not equal to "None"</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Previous Single dose NVP Date1</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>PrevSingleDoseNVPDate</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>mm/yy</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Previous Single dose NVP Date2</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>PrevSingleDoseNVPDate</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>mm/yy</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Regimen (Previous 1st Regimen Name)</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>PrevARVRegimen1Name</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>Select from drug list</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Regimen (Previous 1st Regimen Months)</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>PrevARVRegimen1Months</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Regimen (Previous 2nd Regimen Name)</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>PrevARVRegimen2Name</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>Select from drug list</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Regimen (Previous 2nd Regimen Months)</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>PrevARVRegimen2Months</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Regimen (Previous 3rd Regimen Name)</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>PrevARVRegimen3Name</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>Select from drug list</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Regimen (Previous 3rd Regimen Months)</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>PrevARVRegimen3Months</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Regimen (Previous 4th Regimen Name)</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>PrevARVRegimen4Name</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>Select from drug list</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p>16</p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Regimen (Previous 4th Regimen Months)</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>PrevARVRegimen4Months</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>HIV Associated Conditions</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:105px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:105px; border: solid 1px #000000;"><p>None, Pulmonary TB, Extrapulmonary TB, etc…</p>
</td>
<td valign="top" width="154" style="width:154px; height:105px; border: solid 1px #000000;"><p>mst_HivDisease, dtl_PatientDisease </p>
</td>
<td valign="top" width="74" style="width:74px; height:105px; border: solid 1px #000000;"><p>Disease_pk, DiseaseName</p>
</td>
<td valign="top" width="209" style="width:209px; height:105px; border: solid 1px #000000;"><p>No UI defaults; Not document button required<br>
Pulmonary Smear + and Pulmonary Smear - separated out</p>
</td>
<td valign="top" width="52" style="width:52px; height:105px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:105px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:105px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:105px; border: solid 1px #000000;"><p>Yes [none, conditions entered or not documented must be filled in]</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Physical Exam</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td colspan="3" valign="top" width="147" style="width:147px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Temp (Degrees C)</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>Temp (deg C)</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Field level validation boundaries: 30.0-50.0</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>RR (cpm)</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>RR</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Field level validation boundaries: 4-100</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>HR (bpm)</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>HR</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Field level validation boundaries: 30-200</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>BP Systolic (mm/Hg)</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>BPSystolic</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Field level validation boundaries: 50-250</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>BP Diastolic (mm/Hg)</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>BPDiastolic</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Field level validation boundaries: 30-150</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Ht (cm)</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>Height</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Field level valdiation boundaries: 0-250</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Wt (kg)</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>Weight</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Field level validation boundaries: 0-225</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Pain</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>Pain</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>Pain is on a scale of 1 to 10.</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>WAB Stage</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientStage</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>WABStage</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>[Working, Ambulatory, Bedridden]</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>WHO Stage</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientStage</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>WHOStage</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p>I, II, III, IV]</p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Assessment</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Clinical Assessment - Initial Evaluation</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientAssessment </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>AssessmentID</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>Assessment options: No illness found, HIV-related illness/OI, Non-HIV-related illness</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Clinical Assessment Notes</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientAssessment </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>Description</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Treatment Plan</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Treatment Plan - Initial Evaluation</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientAssessment </p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>AssessmentID</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>Plan options: Lab evaluation/TB screen, OI Prophylaxis/treatment, Treatment Preparation, Other</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Treatment Plan Notes</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientAssessment </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>Description</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>ARV Therapy</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:45px; border: solid 1px #000000;"><p>Treatment not indicated now</p>
</td>
<td valign="top" width="154" style="width:154px; height:45px; border: solid 1px #000000;"><p>dtl_PatientArvTherapy</p>
</td>
<td valign="top" width="74" style="width:74px; height:45px; border: solid 1px #000000;"><p>TherapyPlan</p>
</td>
<td valign="top" width="209" style="width:209px; height:45px; border: solid 1px #000000;"><p>For non-paperless, this is a required field;<br>
For paperless, this is not a requied field.</p>
</td>
<td valign="top" width="52" style="width:52px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:45px; border: solid 1px #000000;"><p>Yes, for non-paperless</p>
</td>
<td valign="top" width="73" style="width:73px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Continue Current</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientArvTherapy</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>TherapyPlan</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Restart Treatment</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientArvTherapy</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>TherapyPlan</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Start New Treatment</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p>dtl_PatientArvTherapy</p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p>TherapyPlan</p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><br>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Change regimen reason code</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientArvTherapy</p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>TherapyReasonCode</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>If currARVTherapy=Change treatment then TherapyReasonCode is required</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:30px; border: solid 1px #000000;"><p>Stop regimen reason code</p>
</td>
<td valign="top" width="154" style="width:154px; height:30px; border: solid 1px #000000;"><p>dtl_PatientArvTherapy</p>
</td>
<td valign="top" width="74" style="width:74px; height:30px; border: solid 1px #000000;"><p>TherapyReasonCode</p>
</td>
<td valign="top" width="209" style="width:209px; height:30px; border: solid 1px #000000;"><p>If currARVTherapy=Stop treatment then TherapyReasonCode is required</p>
</td>
<td valign="top" width="52" style="width:52px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:30px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:15px; border: solid 1px #000000;"><p>Appointment Scheduling</p>
</td>
<td valign="top" width="154" style="width:154px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="209" style="width:209px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:15px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:46px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:46px; border: solid 1px #000000;"><p>When is the patient's next appointment?</p>
</td>
<td valign="top" width="154" style="width:154px; height:46px; border: solid 1px #000000;"><p>Dtl_Patientappointment</p>
</td>
<td valign="top" width="74" style="width:74px; height:46px; border: solid 1px #000000;"><p>Appdate</p>
</td>
<td valign="top" width="209" style="width:209px; height:46px; border: solid 1px #000000;"><p>This needs to be tied into the schedule. The date should be automatically calculated based on appointment period.</p>
</td>
<td valign="top" width="52" style="width:52px; height:46px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:46px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:46px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:46px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:32px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:32px; border: solid 1px #000000;"><p>Next appointment date</p>
</td>
<td valign="top" width="154" style="width:154px; height:32px; border: solid 1px #000000;"><p>Dtl_patientappointment</p>
</td>
<td valign="top" width="74" style="width:74px; height:32px; border: solid 1px #000000;"><p>Appdate  </p>
</td>
<td valign="top" width="209" style="width:209px; height:32px; border: solid 1px #000000;"><p>The date can be entered directly. If a date is entered, then appPeriod is Null.</p>
</td>
<td valign="top" width="52" style="width:52px; height:32px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:32px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:32px; border: solid 1px #000000;"><p>Yes</p>
</td>
<td valign="top" width="69" style="width:69px; height:32px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:32px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:32px; border: solid 1px #000000;"><p>Appointment Reason</p>
</td>
<td valign="top" width="154" style="width:154px; height:32px; border: solid 1px #000000;"><p>Dtl_patientappointment</p>
</td>
<td valign="top" width="74" style="width:74px; height:32px; border: solid 1px #000000;"><p> AppReason</p>
</td>
<td valign="top" width="209" style="width:209px; height:32px; border: solid 1px #000000;"><p>This is a new field: reasons are “Follow up”; “Lab test”; and “Treatment Preparation”</p>
</td>
<td valign="top" width="52" style="width:52px; height:32px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:32px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:32px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:32px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:16px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:16px; border: solid 1px #000000;"><p>Signature</p>
</td>
<td valign="top" width="154" style="width:154px; height:16px; border: solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td valign="top" width="74" style="width:74px; height:16px; border: solid 1px #000000;"><p>signature</p>
</td>
<td valign="top" width="209" style="width:209px; height:16px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="52" style="width:52px; height:16px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:16px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:16px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:16px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td valign="top" width="45" style="width:45px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="93" style="width:93px; height:45px; border: solid 1px #000000;"><p>Print</p>
</td>
<td valign="top" width="154" style="width:154px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="74" style="width:74px; height:45px; border: solid 1px #000000;"><p>Print</p>
</td>
<td valign="top" width="209" style="width:209px; height:45px; border: solid 1px #000000;"><p>This button is used to take hard copy of the form. This is basically feature of paperless, but is implemented for non paperless too</p>
</td>
<td valign="top" width="52" style="width:52px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="64" style="width:64px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="73" style="width:73px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
<td valign="top" width="69" style="width:69px; height:45px; border: solid 1px #000000;"><p> </p>
</td>
</tr>
</table>
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